A recent survey by Lake Research Partners refreshes
our knowledge of barriers to enrollment in Medicaid and CHIP. Commissioned by
CMS for its Connecting Kids to Coverage initiative, the survey interviewed
nearly 2,000 parents with income at or below 250% of the poverty level; about
one-third each with uninsured children, children enrolled in Medicaid/CHIP, or
children covered by employer insurance. Almost a quarter of respondents were
Spanish speakers and as a result, the findings provide insight into the
differences in approaches needed to reach English versus Spanish speaking
families.
Understanding what motivates parents to enroll their
children is helpful to fine-tuning outreach strategies. Integrating effective
marketing messages that cite “peace of mind,” access to services and
affordability are most likely to prompt parents to take action.
* Peace of mind – A large majority (71%) of parents cite
peace of mind as the top reason to enroll their children in coverage.
* Access – Other top motivators include having a regular
doctor for their child (70%) and access to services such as prescription drugs
(69%), dental care (68%) and vision care (65%).
* Affordability – Finding out about the affordability of
the program also prompts families to take action. Having a clear sense of
income eligibility, such as noting the top income level for a family of four,
helps clarify for parents if their children are eligible for coverage.
Identifying and addressing barriers to enrollment are
critical to develop an effective outreach and marketing strategy for Medicaid
and CHIP. While the top issues
come as no surprise, having persisted over time, the survey reinforces the
ongoing need to streamline policy and sustain outreach.
* Difficult enrollment process – Just over half of
parents (51%) without children currently enrolled believe the process is
somewhat or very difficult.
* Income too high – Almost half (43%) of parents without
enrolled children think their family’s income is too high and a quarter (24%)
say they aren’t sure. Even 21% of families with income below the poverty level
believe their income is too high.
* Uncertainty about how to apply – More than one-third of
families with uninsured children (37%) don’t know where/how to apply.
While most parents prefer online, phone and mail
applications, parents in the lowest education and income groups also like the
ability to apply in person at a government office. There were distinct
differences noted on this point in the opinions of English-speaking parents
compared to Spanish-speakers. Notably, 62% of Spanish-speaking parents say they
would be more likely to enroll at a government office compared to only 26% of
English-speaking parents. Of all the enrollment options, the highest percentage
of Spanish speaking parents (72%) liked enrolling by mail. Spanish-speakers
also say they would be more likely to apply if in-language applications and
assistance would be available, and if they would not be questioned about their
own immigration status (which is not relevant to their child’s eligibility).
Outreach, education and enrollment options are important
means to advancing children’s health coverage. However, we know that retention
of eligible children is also a high priority considering that more than
one-third (35%) of uninsured, eligible children were enrolled in the
previous year. The biggest surprise in the survey (at least for me) is that
only two-thirds (67%) of parents who have had a child enrolled in Medicaid or
CHIP were aware of the need to renew their child’s coverage. Clearly this is an
area we must continue to address in our efforts to keep all eligible children
enrolled.
While many of the survey’s findings reaffirm what we know
about barriers and opportunities to improve enrollment, it points to the need
to continue to press forward with ongoing outreach, education and procedural
improvements to ensure that every eligible child is enrolled and retains their
coverage. Businesses conduct market research on an ongoing basis to improve
their results. We should expect nothing less of our public programs if we want
them to perform efficiently and cost-effectively. Thanks to CMS for
commissioning this important market research on something far more valuable
than selling widgets – that is, ensuring the health of America’s children.